abstract

Cleft lip is a common congenital malformation in oral and maxillofacial region, and its incidence rate is about 1: 1000. Normal fetus, after the fifth week, began to gradually merge with some embryonic processes to form a face. If it can't develop normally, it can be deformed, including cleft lip.

diagnose

(a) cleft lip can be divided into:

1. Unilateral cleft lip can be divided into incomplete type and complete type.

2. Bilateral cleft lip has incomplete type, complete type and mixed type, that is, one side is complete type and the other side is incomplete type.

(2) According to the crack degree, it is divided into:

First degree cleft lip is limited to red cleft lip.

Second-degree cleft lip is the upper lip split, not the bottom of the nose. Shallow second degree means that the crack does not exceed1/2 of the lip height; The second depth is 65438+ the crack exceeds 0/2 of the lip height.

Third degree cleft lip is a complete cleft of the upper lip and the bottom of the nose.

Cryptic fissure means that although the skin and mucosa are not cracked, they lack muscle layer.

Treatment measures

(1) operation time

It is generally believed that the operation of unilateral cleft lip is appropriate in about six months, and the operation of bilateral cleft lip is a little late. The basic conditions for children to adapt to surgery are: general health, no obvious anemia, no upper respiratory tract infection, and no infection in local and surrounding tissues.

(2) the basic requirements of surgery

The basic requirement of cleft lip repair surgery is to restore the normal shape and function of lip and nose as much as possible. A normal lip and nose has the following characteristics: the nostrils on both sides are equally round, the tip of the nose and the columella are centered, the alar does not collapse, the upper lip is symmetrical in height, the red lip is plump, the lip bead is slightly protruding, and the red edge of the lip is arched. The above anatomical features can be used as the basis for the design of cleft lip repair surgery.

(3) the surgical method of cleft lip repair

The basic steps of cleft lip repair surgery are fixed-point design, incision and suture. There are many fixed-point design methods. Now only the lower triangular flap method is introduced. The steps are as follows.

1. Fixed point design

1) Find the point on the red edge of the lip first.

Find the peak point D and the lowest point C in the red edge of healthy lips, and then press CB=CD to determine the point B, and the point B' is set at the thickest part of the red edge of affected lips. Finally, B and B are stitched together to form the labial peak of the affected side.

2) measure two basic data

From the base of nasal alar to the base of nasal columella, the width of normal nostril and the base of affected nostril were measured respectively, and the difference between them was X. H measured from the midpoint of the contralateral nasal floor to point D was the normal lip height, that is, the upper lip height that should be restored after the repair operation (Figure 2②③).

3) Set other points and underline them.

The fixing points a and A' are fixed on both sides of the nasal floor fissure. Let AA' be equal to the difference X of the width of the bottom of two nostrils, and make AA' equal after sewing. Connect AB. Subtract AB from normal lip height H to get Y, which is the lip height to be increased on the affected side. At point b, BE is about =y, almost parallel to the red edge of the lower lip. Take A' as the center, AB as the radius, B' as the center, and Y (the lip height to be increased) as the radius, and make an arc that intersects with B "(preferably B'B" is close to perpendicular to the red lip). Take b' b "as the center, BE as the radius, and make an arc intersection with e'. Connect the lines A'B ",B'E' and E' b' (b" e "be careful not to draw the line B'B" and do not make an incision here). After correcting all points, dip the hypodermic needle into the skin with methylene blue, draw a line and fix it with iodine (Figure 2④⑤).

Cutting and sewing

The operation requires meticulous, light, small trauma, accurate incision and neat suture.

When cutting, first pinch the upper lip outside the incision with your fingers to reduce bleeding. Cut A' B \', B \\' E', a' b ",B' E' and E' B" according to the design line. After incision, the upper lip of the healthy side can descend, forming a triangular crack at BE. Insert the B "E' B "triangular tissue flap formed on the affected side into this fissure. The wound edge of A'B line is opposite to a' b ". Suture in layers in turn. Trim the red lip, according to the situation, adopt embedded or Z-shaped double triangular flap method to increase the fullness of the red lip. Generally speaking, patients with nasal deformity advocate postponing the radical operation of nasal deformity after 13 years old.

The fissure of complete cleft lip is wide and the tension is high, so it needs to be cut in the vestibular sulcus for invisible separation, which is convenient for tissue suture in place.

(4) postoperative treatment

1. Fix the upper lip with steel wire lip arch tape for 2 weeks to prevent the wound from cracking and reduce scar healing.

2. After children are awake from basic anesthesia, double elbow joints should be fixed with splint bandages to avoid scratching wounds and reduce the tension of labial arch.

3. Gently wipe the lip wound with 3% hydrogen peroxide and 4% boric acid alcohol to prevent the blood scab from covering and affecting the wound healing.

4. The wound was removed within 5 days.

etiology

The exact causes and pathogenesis of developmental and fusion disorders are not fully understood. According to a large number of experimental research and epidemiological investigation results, it may be caused by many factors rather than a single factor. Generally speaking, it can be divided into genetic factors and environmental factors, which are related to nutrition, heredity, infection, endocrine and other factors.

1. Genetic factors Patients with cleft lip can find similar deformities in their immediate or collateral relatives, so it is considered that cleft lip deformity is related to heredity. Epidemiological investigation shows that the incidence of cleft lip in offspring of relatives with cleft lip deformity is higher than that of relatives without cleft lip deformity. Genetic research also believes that cleft lip is a polygenic genetic disease.

2. Environmental factors mainly refer to the environment of embryo growth and development, and the whole physiological state of the mother constitutes the environmental conditions of embryo development. Therefore, in the first three months of pregnancy, when the maternal physiological state is violated or disturbed, it may affect the growth and development of the embryonic maxillofacial region.

(1) nutritional deficiency in experimental animal studies, it is found that mice will have cleft lip and other deformities when they lack vitamin A, B2, folic acid and other food ingredients, but it is not clear whether humans will also have congenital deformities due to the lack of these substances. Therefore, nutritional deficiency in early pregnancy may be one of the inducing factors.

(2) Infected and injured mothers, if they suffer some kind of damage in the early pregnancy, especially will cause damage to the uterus and its adjacent parts, such as improper incomplete abortion or unscientific drug abortion. , will affect the development of embryos, leading to deformity. Maternal viral diseases such as rubella can also affect the development of embryos and become a possible cause of cleft lip.

(3) Endocrine influence: The baby born after the early pregnancy due to illness and hormone therapy has some congenital malformation. In addition, in the investigation of the family history of children with cleft lip, it is also found that some mothers have various obvious mental trauma factors in the early pregnancy, which may lead to stress reaction, increase the secretion of adrenocortical hormone in the body and induce congenital malformation.

(4) Drug factors Most drugs can enter the embryo through the placenta after entering the mother. Some drugs may affect the development of embryos and cause deformities. At present, the known anti-tumor drugs (such as cyclophosphamide, methotrexate, etc. ), anticonvulsants (phenytoin sodium), histamine drugs and some sleeping pills (such as thalidomide) can all cause fetal malformation.

(5) Pregnant women's frequent exposure to radiation or microwave and other physical injuries during fetal development may affect the growth and development of the fetus and become the possible cause of cleft lip.

(6) Alcohol and tobacco factors Smoking and drinking heavily in the early pregnancy, the incidence of cleft lip in their children is higher than that in women without alcohol and tobacco hobbies, which is also one of the possible factors leading to fetal cleft lip.

clinical picture

The main manifestation of cleft lip is upper cleft lip. It can be divided into three degrees according to the location and degree of cracks.

1. First-degree cleft lip is just red lip.

2. The second degree is that the fissure exceeds the red lip but does not reach the bottom of the nose.

3. The third degree is that the tear is completely split from the red lip to the bottom of the nose. The first two kinds are also called incomplete cleft lip, and the last one is called complete cleft lip.